Jill Wechsler
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The health reform bandwagon is picking up steam, and health plans are offering proposals to stay on board. Industry is backing
policy changes that expand healthcare coverage for the uninsured and reduce discriminatory coverage. There is support for
bolstering Medicaid, along with tax credits and subsidies to help lower-income families pay the premiums.
The Senate Finance Committee has held a series of high-profile health reform roundtables, followed by members-only meetings
to hash out legislative proposals. Finance leaders are working with members of the Senate Health, Education, Labor and Pensions
(HELP) Committee with an eye to developing joint legislation this month for full Senate consideration in July.
Leaders of three House committees that oversee segments of the nation's healthcare system are working together to enact a
reform plan before Congress' August recess. Rep. Henry Waxman (D-Calif.), chairman of the House Energy and Commerce Committee,
has predicted that Congress will agree on health reform legislation by fall, and that President Obama will sign the final
measure by year-end.
The legislators have begun by seeking agreement on basic elements of a reformed healthcare system: Individual coverage mandate. There is early bi-partisan support for requiring all individuals to have coverage or pay a fine. Insurers back an individual
mandate as necessary to prevent people from waiting until they get sick to sign up for coverage.
Employer "play or pay." Democrats also want most employers (those with more than $500,000 total payroll) to subsidize 50% of workers' health insurance
premiums or pay an assessment.
Insurance exchange or market. A national health insurance exchange would offer a variety of plans to individuals and small businesses seeking coverage.
A standard application form would facilitate plan selection.
National basic benefits. Health plans listed on the exchange would have to offer standard sets of benefits covering doctors' services, hospital care
and prescription drugs, and there would be no annual or lifetime coverage limits.
More regulation. The federal government would regulate commercial insurance marketing, including sales commissions to agents and brokers.
MARKET REFORMS
To indicate they are serious about overhauling the current system, insurers are backing broader market reform in a universal
coverage system. In a major turnaround from previous policies, America's Health Insurance Plans (AHIP) and the Blue Cross
and Blue Shield Assn. support guaranteed coverage for people with pre-existing conditions and an end to higher premiums for
individuals with serious illnesses.
In addition, at a Senate Finance Committee hearing last month, AHIP President Karen Ignagni backed an end to higher rates
for women obtaining the same coverage as men, again under a universal coverage system. Sen. John Kerry (D-Mass.) blasted gender-based
rates and proposed legislation to end the practice.
Ignagni emphasized industry support for "a complete overhaul of existing regulatory mechanisms," including changes in state
rules and stiffer penalties to enforce new standards. Big questions are how new policies will affect state insurance regulation,
and, of course, how to pay for expanded coverage.
Jill Wechsler, a veteran reporter, has been covering Capitol Hill since 1994.
